Fillable Va Enrollment Form (Page 2 of 2) in pdf

Student Name

Student ID

PART 3 - POST 9/11 GI BILL INFORMATION (Chapter 33 ONLY)

What is/was your training start date (date you indicated as training start/enrollment date on VONAPP)?

(mm/dd/yyyy)

Have you applied for the WI GI Bill®?

Yes

No*

*To be reviewed for a WI GI Bill® Supplemental Payment, you must apply for the WI GI Bill and be determined eligible. If you

have not yet applied, complete the WDVA B0105 packet (dva.state.wi.us) and submit as instructed on the top of each form.

When you applied for Post-9/11, which chapter did you relinquish?

Chapter 30 - If you were eligible for Chapter 30, what amount of active duty did you have after 9/10/2001?

Less than 3 years

More than 3 years

Chapter 1606

Chapter 1607 - If you were eligible for chapter 1607, what was your longest consecutive period of active duty?

More than 90 Days, but less than 1 year

More than 1 year

More than 2 years

None

Part 4 - ADDITIONAL BENEFIT INFORMATION (All chapters)

Do you have a Kicker?

Yes

If yes:

What was the amount of your Kicker? $

Please provide documentation to Madison College Veterans Services (e.g., kicker contract, etc.).

Do you have a Buy Up?

Yes

If yes:

What was the amount of your Buy Up?

Please provide documentation to Madison College Veterans Services (e.g., LES, DD214.).

Will you be on Terminal Leave at the start of your first semester?

Yes

If yes: On what date will your Terminal Leave end?

(mm/dd/yyyy)

Part 4 - IMPORTANT VETERANS EDUCATION BENEFIT INFORMATION - Please read carefully.

• The payment of veterans education benefits requires a student to be enrolled in and attending class. Classes that do not

run from term start to term end may affect VA payment depending on your class schedule (e.g., short-term and interim

classes may run fewer than 12 weeks and may not meet the credit requirement for full time status for the entire length of the

term).

• Tuition and fees will be taken from the first payment regardless of the source.

• Chapter 33 recipients who withdraw or fail to attend class are responsible for repaying housing, book stipend, tuition and fees

to the VA.

• Chapter 31 - Vocational Rehab recipients: By submitting this form, students give permission for Madison College to release

their class schedule, grades and GPA to their Vocational Rehabilitation counselor.

• If a student receiving VA benefits drops or adds a class, or changes enrollment in any way, it is the student's responsibility to

notify Madison College Veterans Services immediately by email at . Changes in enrollment

could result in an overpayment, which may require repayment of monies received to the VA.

• Chapter 30, 1606 and 1607 recipients must verify your enrollment every month with the VA online from the GI Bill® website at

gibill.va.gov or by phone at (877) 823-2378.

• Students admitted to a program waitlist may only have those classes required by the program certified to the VA for veterans

education benefits. Once a student has completed all the pre-program classes available to them they may not have additional

courses certified until they are admitted to their program.

• The VA requires that all students receiving benefits be enrolled in a program of study. In addition, the school is required by the VA to only certify

courses that are required by a student's program. Repeated courses will only be certified if initial grade earned was lower than program requirements.

• Students who fail to obtain a cumulative grade point average of at least 2.0 are placed on academic probation. Failure to achieve a satisfactory

grade point average of 2.0 or better for the subsequent probationary semester may result in Madison College being unable to certify future enrollment.

Part 5 - SIGNATURE & AGREEMENT

By signing, I certify that I have read and understand the information provided on this form. I also give permission for the school

certifying official to review my educational records and release information regarding VA education benefits as requested by state,

federal or other agencies.

Student Signature

Date

SUBMISSION INSTRUCTIONS

Please sign and submit your completed form and supporting documentation in-person to the Truax Enrollment Center - Room A1000, Downtown

Enrollment Information Center - Room D117, or any Regional or Metro Campus Office; or submit by mail or fax:

Address:

Madison College Veterans Services

Fax: